Battle Of The RN's: Emergency Room Vs Floor Nurse!

EmergencyNrse · Oct 15, 2011

Wow, been at least a day or two for a really good troll-like topic.

Sorry I'm late...

The ER is awesome and the floor sucks. (How's that?)

meandragonbrett · Oct 15, 2011

You can have up to 14 patients with varying acuity? I call garbage. How many beds is your ED? That makes absolutely no sense. If it's true you need to find a new job.

vanburbian · Oct 15, 2011

A new grad with 14 pt.'s,. and some on vents? I'd be so outta there.....My pod's are either 3 to 4 pt. units, and we may have one in the hall.

We have one tech, but we do everything ourselves, as the tech babysits the psych pt.'s.

We have psych beds (rare things those) at our hospital, so the chronically mentally ill are FF's in our ED, and we board many psych pt.'s for days.

We are only a 15 bed ER, but we see average ~100-110 pt,'s a day.

I would quit so fast I'd set the building on fire as I ran out if I had 10 to 14 ED patients, some critical.

johnjacksoniv · Oct 15, 2011

did the world need another self important ed nurse?

i trained in the ed of a large navy hospital before transitioning to a "floor nurse". i now work on a specialty unit of a 350+ bed trauma center in a major american city.

its all about perspective. me being negative: here is my view on an average report from an ed nurse. it starts with a statement like, " i don't know this patient but..." . this translates into i haven't assessed the patient. then the focus of the report is on the dx and the size of iv access that is inevitably placed in the ac. if pressed for more pertinent assessment data the nurse will usually pull the phone away from their ear, shuffle some papers, get back on the phone and sound more confused. the end.

me being positive: most of us worked hard to become nurses because we care about others. the focus shouldn't be on silly infighting but on delivering excellent patient care.

locolorenzo22, BSN, RN · Oct 15, 2011

Ok, here's some issues for me.

Floor nurses are not allowed to:

Draw blood (If it's stat, the MD must draw it, if not phlebotomy)

same at my hospital. I wouldn't even know where to start. if I was trained, ok then. Lab does all our draws, but I do call and give them a heads up when it's stat.

Don't know how to start IV's due to having an IV team (well that's gone now)

True on the day shift, but sometimes they do start them. Nights it's just the staff. We either have the house super or ICU nurses come start our hard sticks if we can't get them.

Can't push any medications (if they do the MD must push the first dose)

What? Doubt it. Simple meds that any nurse could do if educated? I don't think you understand this correctly. Perhaps it's only some drugs.

Cannot receive patients on any drip (somewhat understanable if it's an ICU type drug)

Hospital policy. not their fault. We have only certain drips that can come to us. We're like a stepdown tele, not a ICU.

I even had one question if the patient could come to the tele floor because the troponin was something like 0.248????? Troponin can be elevated in chronic kidney patients, cardiac hx patients, many different reasons.

So I work nights. Now please don't get me wrong, I respect floor nurses, but I think this is incredibly obsurd, what do they do up there? pop meds? My ER is extremely busy. While they get a base 6-7 patients, sometimes 10 they tell me, we can get up to 14 patients all with varying acuities. Sometimes we have an ICU patient with another 7-8 patients because we're bursting at the seams, and this is not occasional, this is pretty much every day.

Your ratio is horrible! It's totally insane. but just because they have less patients, doesn't mean they aren't working. If you're going to complain about your ratio, then talk to your manager. don't make it sound like they're choosing to take less. If you don't like it, then change units.

I've had floor nurses call me and scream because the patient is soaking wet, then she says

were you busy, because if you were busy it's ok" like really? was I busy? this is the ER what do you think?. We don't have nurses' aides like they do, they took them out of the ER for budget purposes and all we have is one tech per 12-24 patients and they're stuck doing vitals, EKG's and helping out with bedpans etcc...

Well, I'm sorry that your tech is lost. But, if they are doing vitals, ekgs, etc....then why not a quick check right before patient leaves ER. wet is ok, soaking wet....no. sometimes they pee on the way up. I don't blame the ER. If they're calling you, say "sorry." and leave it at that.

Before the patients go up to their rooms the internal medicine residents beg us to drawn another set of blood, when asked why? oh because the nurses upstairs can't do it!!! really?

Again, a matter of policy. you fix it.

I feel like our light days in the ER would be consider heavy to them. The other day I had two patients who had beds upstairs. One was a tele, who's HR was in the high 30's low 40's and another was a vent. So I call to give report and the clerk says can you call back because the nurse had to run an RRT and take the patient to the ICU. Fine I called back 40 min later and she's still unavailable? :mad: So then the supervisor calls the ER and tells the charge nurse to hold the patients for 3 hours in the ER because the floor nurses are overwhelmed and understaffed this is at 4 am in the morning?

Perhaps they are. I've been tied up for 2 hours in a RRT and ICU tx and report, and assessment, etc. You cannot judge that nurse for being unavilable. crap happens. You aren't on the floor. I'm sorry that you think the floor nurses aren't understaffed. Usually my floor is so I can't share your sympathy.

Well guess what happens? The vent turns into a ICU evaluation, I get about 3-4 more patients from triage on top of the 4 I already had, so yes now I'm overwhelmed!!! :mad: where's my relief? It's like they throw everything on the ER nurses where I work. The residents even tell us that it's easier and faster to get things done down in the ER with us.

Not to mention they lie to us upstairs. They tell us the rooms are not cleaned and ready when they are. Or when we call to give report they complain that they just got a patient or that that bed was just booked. I've even had them threatent to call the supervisor (which the supervisor never addresses it lol)You know I wish I could tell everyone in the waiting room and triage area to go home because I'm overwhelmed .

Ok, I've had this happen. I've been guilty of it a time or two. But ONLY when I'm so frazzled I just need the 10 minutes to pee, drink, and have a snack. When we're coding people, and just got back, when the patients are driving us crazy. I don't make a habit of it though.

I think it's an awesome idea to float floor nurses through the ER , give them a taste of the exhilaration!

NO. sorry....let me repeat that. NO. If someone wanted to work ER, they would. end of story. I'd be lost unless I had some walkie talkies, and would not be comfortable in a trauma, etc. You have NO right to suggest this.

I'm sorry, I'm a new RN and I've grown to see the huge difference in skill, mindset, and knowledge base of the floor vs critical care/ER nurse. :twocents:

THIS RIGHT HERE IS THE BIGGEST REASON WHY I DON'T TAKE A LOT OF THIS POST SERIOUSLY. I've been a CNA for 2 years, and a RN for 4. I worked a "floor" with ortho/post ops/medicals/detox, all but heart. Now I work tele, and learning every day, but I know a lot. I'm not naive enough to think I know everything. Some floor nurses ROCK, some ICU nurses barely care enough to turn patients, and make mistakes all the time. A nurse is who a nurse is. It does not matter where they work. How long have you been a nurse? you say you're new, and you're already coming off as a arrogant, snobbish person, judging every nurse based on where they work. Come talk to us when you have a year of exp. done.

Anna Flaxis, BSN, RN · Oct 15, 2011

its all about perspective. me being negative: here is my view on an average report from an ed nurse. it starts with a statement like, " i don't know this patient but..." . this translates into i haven't assessed the patient. then the focus of the report is on the dx and the size of iv access that is inevitably placed in the ac. if pressed for more pertinent assessment data the nurse will usually pull the phone away from their ear, shuffle some papers, get back on the phone and sound more confused. the end.

lol, it used to drive me bananas when i got an ed report like this! i used to wonder wth they were doing down there that they couldn't even give a decent report! :rolleyes:

well, now the shoe is on the other foot, and i completely understand!

Anna Flaxis, BSN, RN · Oct 15, 2011

I haven't read all the posts in this thread, but to the OP, it's no cakewalk upstairs either! Nurses are overworked and patients become unstable on the inpatient unit too!

There are incredibly skilled and knowledgeable nurses working the floors! Drawing blood and inserting PIVs is NOT a measure of a nurse's skill, nor is what medication can be given by whom.

Rather than suggesting that the floor nurse should take a shift in the ED, I would like to see you take a patient load on the floor.

Sometimes things can feel adversarial between units. I've had the inpatient units buck admissions before, and I know how frustrating that can be from the side of the ED nurse. But, having been on the floor, I also know how it feels to be the inpatient nurse who simply cannot take another patient right now, and feels like the ED is cramming another patient down your throat, ready or not. Or how it feels when you get a patient who is a complete mess; soaking wet, IV dressing so loose it's hanging by a thread, ready to fall out, blood pressure in the toilet, angry because they've been lying in the ED gurney for six hours and haven't had anything to eat....and the family members are all exhausted and crabby and demanding to be served the second they hit the floor.

That's why I try to make sure the patient is at least straightened up a little with a fresh gown if it got soaked with perspiration, a fresh CHUX pad under their bottom, etc. I warn them that on the inpatient unit, blood cannot be drawn through the PIV and that they will be poked for lab draws. I warn them that it might take a few minutes for them to get food, not to expect it the second they get up there, etc. I know what it's like to be on the receiving end, and so I do what I can to make the transition a little easier. But sometimes things are so chaotic in the ED that I have sent a patient or two upstairs a complete mess. I will admit it. I don't like to do it, and I get why the receiving nurse might be angry, but sometimes it happens.

But in the end, it's all about the patient, not who is more skilled than who. If I have a patient who's been lying on that stretcher for eight hours, and all I have to feed them is juice and crackers, of course I want to do what I can to get them up there as soon as humanly possible. That is what I would like the nurses upstairs to understand. I'm not trying to cram this patient down your throat with total disregard to the fact that you are overworked, but this person is really suffering down here because I simply cannot provide the comforts that you can.

I've had some bad experiences with inpatient nurses who have given me a less than warm reception and picked apart every little thing I didn't do, but I've also had some great experiences with nurses that get it, and just take the patient without a fuss. Those are the kinds of experiences I like to focus on and enculturate whenever possible, by telling my charge nurse or the house supervisor about that wonderful nurse upstairs (by name) who took my patient without any attitude at all, and was so super nice and welcoming to the patient.

beckster_01, BSN, RN · Oct 15, 2011

Psh...I wanna work at the OP's hospital... no IV's, no blood draws, no IVP? Haha jk but seriously if I didn't do any of that I might as well be a tech that can pass meds. It takes more time to find someone to draw blood for me than it does to just grab a set-up and go. Usually blood draws on days are timed so I really don't have time to wait for someone else to do it. I suck at IV's but we at least have to try twice before calling IV service.

The only bone I have to pick with the ED (or ICU's or PACU or anyone else I get my transfers from): WHY oh WHY do you have to wait until 1830 to send the transfer I have been expecting since 1500? And then tell me that they have been stable since they got out of surgery at 1300. I understand you have to keep them for a certain amount of time, but if I have a ready bed and the patient is stable, please send them to me so I can get them settled and taken care of before the next shift comes in. That is all, beyond that I truly appreciate the type of work an ED nurse does! I know I couldn't do it.

MassED, BSN, RN · Oct 15, 2011

uggg makes me feel better about my cushy psych job ..

cushy and psych just do NOT go together... :no:

MassED, BSN, RN · Oct 15, 2011

did the world need another self important ed nurse?
i trained in the ed of a large navy hospital before transitioning to a "floor nurse". i now work on a specialty unit of a 350+ bed trauma center in a major american city.
its all about perspective. me being negative: here is my view on an average report from an ed nurse. it starts with a statement like, " i don't know this patient but..." . this translates into i haven't assessed the patient. then the focus of the report is on the dx and the size of iv access that is inevitably placed in the ac. if pressed for more pertinent assessment data the nurse will usually pull the phone away from their ear, shuffle some papers, get back on the phone and sound more confused. the end.
me being positive: most of us worked hard to become nurses because we care about others. the focus shouldn't be on silly infighting but on delivering excellent patient care.

ahhh, another floor nurse not understanding that when you choose tnot to take report after the original nurse that had that patient has left, you get the oncoming nurse. no, they do not know the patient, so they need to flip through the notes. you know that the patients come into the ed with an unknown diagnosis, right??? i mean, really. that is why we start iv's in the antecubital, for the last time!!!! we do not know if they'll need a ct of the chest/abdomen/or pelvis, and so requires that location - us, as brilliant ed nurses know that this location is required so as we initiate all of our interventions, we anticipate orders (we get to do that in the er) and go from there.

this battle will forever continue on the end of a floor nurse as long as that floor nurse has never been in an ed. come work in one, you'll be sure to run back to your floor and say how much you hate the confusion, chaos, orders, too many things to do on all four or five of your patients all at once. try it.

Home Health Columnist / Guide · Oct 15, 2011

moved to our nurse colleague / patient relations forum.

brainkandy87 · Oct 19, 2011

I'm glad I ran across this thread. I just graduated in May and did my preceptorship in the ER of the hospital I'm employed at on the Step Down Unit. In other words, I've seen both areas of my hospital. And I couldn't be happier that I didn't end up working in our ER.

My complaints:

Our ER is very elitist. They have no respect for floor nurses (or any other dept in the hospital for that matter) and think we do absolutely nothing. I caught one of them calling us the "Sit Down Unit" one night and called him on it. What did I call him on? Well, let's see: they bring up unstable patients (they've brought me severely hypotensive and hypoglycemic pts without letting me know about it), they don't call report and then complain when you ask for it, and on and on.

I always thought floor nurses were lazy too. I was attracted to the fast pace and excitement of the ER. However, what I've found as a floor nurse is that I am more involved with taking care of my patients than I ever was in the ER. Lazy is far from what I am. Each area is a completely different style of nursing. In the ER, you shove an 18 gauge in the AC because, in an emergency situation, it's an easy IV site to access. On the floor, I can put a 24 or 22 in someone's forearm that will be a smaller risk of infection and less painful for the patient. In the ER, you're not worried about providing comfort for the patient, you're worried about stabilizing and keeping that patient alive. On the floor, I concern myself with making sure my patient is comfortable and healing.

All that being said, despite these being two completely different styles of nursing, these two nurses should not dislike the other. I see it in my hospital and I know it's the same at every hospital. We should work together and appreciate each other for what they do, not consider one better or worse.